5 ms·

The US government is the “single payer” for defense contracts. How has that worked out in terms of cost controls?

noir_lord 7y ago
The NHS in the UK pays much lower prices for most drugs than the insurers do (there are the odd egregious cases where a company take the piss, the interesting thing is that we do actually fine them in a rare case of consequences been applied) because simply put they are negotiating for 65 million consumers in one go, if the NHS price is high enough for them to make a healthy profit per patient it is a no brainer. The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence). Is it perfect, no, few human things are. Is it massively preferable to the average healthcare situation for Americans - hell yes it is. I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1] So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work. So if costs controls in government are your concern the elect better people with better systems. Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948). [1] https://apps.nhsbsa.nhs.uk/ppc-online/patient.do https://apps.nhsbsa.nhs.uk/ppc-online/patient.do
- didgeoridoo 7y ago
  You would think that the government gains “leverage” by being the only payer. In practice in the US, this is not what happens. Rampant lobbying (i.e. legal bribery) by interested parties causes spending to spiral out of control, since the benefits are focused and the costs are diffuse. Arguably the NHS model is the only way to get government healthcare to work at all in the US. You would need to gut both private insurance and private hospitals, whose continued political clout would naturally drive up costs if they were allowed to continue existing in their current form. (In fact, there is already an “NHS-like” example in the US: VA Hospitals for veterans. I’m not sure what we can learn from them, however, as lessons from treating the veteran population may not be able to be extrapolated to the other 300+ million of us.)
  - coredog64 7y ago
    One possible lesson: Every veteran I know thinks of the VA as the provider of last resort. You can’t sue the government unless they decide to allow it, so at least we’ll see the end of malpractice suits. /sarc
    - IG_Semmelweiss 7y ago
      The VA had a massive scandal recently. For years, they had chronic problems with timely follow ups and treatment (ergo. Last resort). They were put on notice to improve their patient turnaround times. Miracle ensued -wait times did go down. But as always, bureaucrats played with stats: they achieved the drop by literally IGNORING veterans seeking medical service and appointments. They would simply find a reason to not log the event at all. This went on for the better part of the year when veterans started dying in greater numbers and someone blew the whistle. Claims of reform were made. No one got fired until trump got elected.yet now we start all over again. VA is not what you want for USA
- rayiner 7y ago
  > Is it massively preferable to the average healthcare situation for Americans - hell yes it is. Your average American has employer-paid health insurance, which covers most of their costs. According to the OECD, average out-of-pocket healthcare expenditure in the U.S. is $1,370, versus $629 in the U.K. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm. Keep in mind that median household disposable (post-tax) income in the U.S. is $45,000, versus $29,000 in the U.K.
  - stevekemp2 7y ago
    Sure, but there are obvious cases which turn these averages into really different personal-stories. One case is the obvious cost of having a child in America, even with insurance some people pay thousands of dollars.
    - vonmoltke 7y ago
      The point is that "some people" is not "average". If we are going to talk about the problems with health care in the US exaggerating the problems is counterproductive.
      - seandougall 7y ago
        Does that mean poverty is not a problem worth addressing, because on average we’re a reasonably wealthy country? Is inequality not a problem, because on average we all have the same opportunities?
    - rayiner 7y ago
      "The american system is bad for the poor or unlucky" is a very different argument than "the american system is bad for the average person." The difference in median disposable income between the U.S. and the U.K. is stunning: almost $17,000. Even after you factor in things like student loan debt (averaging $220/month for the minority of people who have student loans at all) and out-of-pocket healthcare expenses and premiums (a few thousand a year on average, versus maybe a thousand or so in other OECD countries), the median American household is coming out way ahead.
- IG_Semmelweiss 7y ago
  I am not going to advocate against negotiating lower prices. However, i should point out that one reason the NHS drug benefit (and that of mostly every country) is not completely broken and obsolete is because USA effectively subsidizes research for drugs that the rest of the world then copies

The NHS in the UK pays much lower prices for most drugs than the insurers do (there are the odd egregious cases where a company take the piss, the interesting thing is that we do actually fine them in a rare case of consequences been applied) because simply put they are negotiating for 65 million consumers in one go, if the NHS price is high enough for them to make a healthy profit per patient it is a no brainer. The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence). Is it perfect, no, few human things are. Is it massively preferable to the average healthcare situation for Americans - hell yes it is. I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1] So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work. So if costs controls in government are your concern the elect better people with better systems. Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948). [1] https://apps.nhsbsa.nhs.uk/ppc-online/patient.do https://apps.nhsbsa.nhs.uk/ppc-online/patient.do

didgeoridoo 7y ago
You would think that the government gains “leverage” by being the only payer. In practice in the US, this is not what happens. Rampant lobbying (i.e. legal bribery) by interested parties causes spending to spiral out of control, since the benefits are focused and the costs are diffuse. Arguably the NHS model is the only way to get government healthcare to work at all in the US. You would need to gut both private insurance and private hospitals, whose continued political clout would naturally drive up costs if they were allowed to continue existing in their current form. (In fact, there is already an “NHS-like” example in the US: VA Hospitals for veterans. I’m not sure what we can learn from them, however, as lessons from treating the veteran population may not be able to be extrapolated to the other 300+ million of us.)
- coredog64 7y ago
  One possible lesson: Every veteran I know thinks of the VA as the provider of last resort. You can’t sue the government unless they decide to allow it, so at least we’ll see the end of malpractice suits. /sarc
  - IG_Semmelweiss 7y ago
    The VA had a massive scandal recently. For years, they had chronic problems with timely follow ups and treatment (ergo. Last resort). They were put on notice to improve their patient turnaround times. Miracle ensued -wait times did go down. But as always, bureaucrats played with stats: they achieved the drop by literally IGNORING veterans seeking medical service and appointments. They would simply find a reason to not log the event at all. This went on for the better part of the year when veterans started dying in greater numbers and someone blew the whistle. Claims of reform were made. No one got fired until trump got elected.yet now we start all over again. VA is not what you want for USA
rayiner 7y ago
> Is it massively preferable to the average healthcare situation for Americans - hell yes it is. Your average American has employer-paid health insurance, which covers most of their costs. According to the OECD, average out-of-pocket healthcare expenditure in the U.S. is $1,370, versus $629 in the U.K. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm. Keep in mind that median household disposable (post-tax) income in the U.S. is $45,000, versus $29,000 in the U.K.
- stevekemp2 7y ago
  Sure, but there are obvious cases which turn these averages into really different personal-stories. One case is the obvious cost of having a child in America, even with insurance some people pay thousands of dollars.
  - vonmoltke 7y ago
    The point is that "some people" is not "average". If we are going to talk about the problems with health care in the US exaggerating the problems is counterproductive.
    - seandougall 7y ago
      Does that mean poverty is not a problem worth addressing, because on average we’re a reasonably wealthy country? Is inequality not a problem, because on average we all have the same opportunities?
  - rayiner 7y ago
    "The american system is bad for the poor or unlucky" is a very different argument than "the american system is bad for the average person." The difference in median disposable income between the U.S. and the U.K. is stunning: almost $17,000. Even after you factor in things like student loan debt (averaging $220/month for the minority of people who have student loans at all) and out-of-pocket healthcare expenses and premiums (a few thousand a year on average, versus maybe a thousand or so in other OECD countries), the median American household is coming out way ahead.
IG_Semmelweiss 7y ago
I am not going to advocate against negotiating lower prices. However, i should point out that one reason the NHS drug benefit (and that of mostly every country) is not completely broken and obsolete is because USA effectively subsidizes research for drugs that the rest of the world then copies